Trauma Consults by Geriatricians: Looking into the Black Box.

The conceptual framework, targeting of older adults, and content of a targeted geriatric trauma consult (GTC) performed by geriatricians at a Level 1 trauma center are highlighted. The GTC is designed to optimize patient care through comprehensive assessment and to interrupt the disablement process. In a performance improvement study, fellowship-trained and certified geriatricians conducted the GTC in 98 patients ranging in age from 68 to 100 years. Most common recommendations by the geriatricians were for transitions of care (e.g., home health, skilled nursing facility, hospice), changes in medications (e.g., antihypertensives, antidepressants/antipsychotics), advanced care planning, and specialist referral. Targeted GTC performed by a geriatrician is an efficient approach to comanagement of complex older trauma patients, in contrast to mandated geriatric team consultation. In settings of value-based care, GTC by a geriatrician has potential to reduce patient disability and health care costs compared with usual care of older trauma patients.